Social epidemiology and determinants of health in Fiji: social, cultural, and environmental factors influencing public health status, climate change and rates of Leptospirosis

Abstract

Ology Press Citation: Mangum TL, Mangum BP. Social epidemiology and determinants of health in Fiji: social, cultural, and environmental factors influencing public health status, climate change and rates of Leptospirosis. Fiji is an island nation located in the South Pacific east of Hawaii and north of Australia and New Zealand. With a population of just over 800,000, 1 Fiji is the largest population hub of the Pacific islands, and is the economic and educational centre of the South Pacific. With approximately 160 islands, the demographics, health, and public health status of Fiji varies widely from the urban centres of Suva, Sigatouka, Nadi, Lautoka, and Labasa; to the small, sparsely inhabited islands of the outer groups. 1 The bulk of the economy of Fiji is based on tourism, with the majority of resorts found on the larger islands, such as Viti Levu, which is home to the capital and largest city of Suva, as well as three of the other large population centres. 1 For a Pacific island nation, the healthcare and public health infrastructure of Fiji is highly developed; however, such development is below that of industrialized nations such as the United States. Still, Fiji is home to two medical schools, including the College of Medicine, Nursing, and Health Sciences of Fiji National University (FNU), and the University of the South Pacific; two nursing schools, one located within FNU, and an additional private nursing school; and a large number of allied health programs found within FNU, including dentistry, radiography, laboratory science, pharmacy, and public health at the undergraduate and graduate levels. The Ministry of Health (MOH) of Fiji is responsible for both medical and public health services. Fiji is serviced by a single referral and teaching hospital in the form of Colonial War Memorial Hospital in Suva, and additional divisional hospitals in the major population centres, sub-divisional hospitals serving smaller communities, and nursing and medical posts in remote areas. Each division of the healthcare system is also supported by an associated division of the public health system. Despite a robust organizational structure, in practice there are significant areas for improvement in both the medical and public health spheres, including a lack of specially trained human resources in areas such as epidemiology and medical subspecialties, as well as the need for additional physical and economic resources for preventative services. The purpose of this paper is to examine the generalized social determinants of health for Fiji as mediated by regional issues such as climate change and rapidly growing rates of non-communicable diseases (NCDs) such as type 2 diabetes, obesity, and cardiovascular disease through the lenses of physical and social factors present in the islands; and then to discuss how these factors have contributed to an ongoing burden of infectious diseases in the region, specifically leptospirosis, including a discussion of the impact of leptospirosis as mediated by cultural and social factors. Abstract Social determinants of health play a major role in the development of sustainable healthcare systems in much of the Pacific. This includes Fiji, which is the largest of the Pacific island nations, and is in many ways a leader if health in the region. Despite this, Fiji, along with the entire Pacific, continues to labour under a heavy burden of both non-communicable, as well as communicable diseases, including emerging and re-emerging infectious diseases, such as leptospirosis, all of which is mediated by economic conditions and the growing threat of climate change. This monograph explores the social epidemiology of health determinants of health in Fiji from the standpoint of social, cultural, and environmental factors; before looking at the impact of such on public health systems and population health status, climate change and disease rates, and finally, the impact of such on the rising rates of leptospirosis regionally.